BACKGROUND: Sex- and gender-associated differences determine the disease response to treatment. AIM: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. METHODS AND RESULTS: We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03-3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0-2.23]), and also for an optimal procedural result (4.24 [2.12-8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], p = 0.029). CONCLUSION: The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.

Cardiocentre 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czechia

Department of Cardioangiology International Clinical Research Center St Anne's University Hospital Brno Brno Czechia

Department of Cardiology Charles University University Hospital in Pilsen Pilsen Czechia

Department of Cardiology Institute of Clinical and Experimental Medicine Prague Czechia

Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University General University Hospital Prague Czechia

Department of Internal and Cardiology Faculty of Medicine Masaryk University and University Hospital Brno Bohunice Brno Czechia

Institute of Biostatistics and Analyses Ltd Faculty of Medicine Masaryk University Brno Czechia

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